| NPI | 1730720939 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5315213589) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI 5601009696) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2019-11-19 |