| NPI | 1710435961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007932) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601007932) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2020-10-19 |