| NPI | 1780071829 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5182) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601012694) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2025-01-06 |