| NPI | 1639775430 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 11016) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010790) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2025-12-18 |