| NPI | 1619454105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010797) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4879) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2023-03-14 |