| NPI | 1376112292 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012179) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007023RX) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-08-16 |