| NPI | 1629776604 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 7406-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601012831) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2025-01-13 |