| NPI | 1457035933 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011947) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: tbd) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-09-05 |