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 |