| NPI | 1659914646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012966) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 024089-01) |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2025-06-03 |