| NPI | 1457082034 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011846) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2024-10-21 |