| NPI | 1790555126 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012246) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-02-26 |