| NPI | 1700552650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011582) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601011582) |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2026-05-21 |