| NPI | 1598354441 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13059862-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010373) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2024-01-10 |