| NPI | 1528431228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008471) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007603) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2024-07-22 |