| NPI | 1679859300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2019022166) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008140) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2024-04-05 |