| NPI | 1720556335 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009593) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2021-09-07 |