| NPI | 1730740507 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5601009510) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2020-02-27 |