| NPI | 1790187193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007171) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI 5601007171) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2022-07-08 |