| NPI | 1710458195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 4584) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008924) |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2022-10-27 |