| NPI | 1538995758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MI 5601012665) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601012665) |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2025-06-06 |