| NPI | 1841841673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-09472) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-09472) | |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2025-03-23 |