| NPI | 1760930424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012590) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53769) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2025-06-09 |