| NPI | 1811453525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010612) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56509) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 56509) | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-07-13 |