| NPI | 1790013878 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011408) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014933) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2023-02-14 |