| NPI | 1730608712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9118427) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601008382) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2024-05-06 |