| NPI | 1669868535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008032) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601008032) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-07-21 |