| NPI | 1700164720 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601006088) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006088) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2024-09-09 |