| NPI | 1760293641 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601012983) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601012983) |
| Enumeration Date | 2025-01-18 |
| Last Update Date | 2025-02-05 |