| NPI | 1780051227 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52777) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2019-02-04 |