| NPI | 1780321539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011614) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: LA 333077) | |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2023-09-13 |