| NPI | 1700448917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004649) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010276) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2024-11-07 |