| NPI | 1639229826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006249) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002550) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2024-01-23 |