| NPI | 1750933008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012631) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13832) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-09-30 |