| NPI | 1386195295 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007944) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-14027) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2026-01-08 |