| 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 |