| NPI | 1669820544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011669) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2017-0098) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2023-10-19 |