| NPI | 1376274001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011825) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA01829) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2025-11-17 |