| NPI | 1790399020 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010191) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006689RX) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2024-10-10 |