| NPI | 1700111507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005661) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601005661) |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2022-12-06 |