| NPI | 1750007845 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011223) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner (Licence: MI 5601011223) | |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2022-10-20 |