| NPI | 1811349582 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-06596) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: MI 5601009492) | |
| 363A00000X Physician Assistant (Licence: MA PA7834) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2023-05-31 |