| NPI | 1861154544 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601010839) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010839) |
| Enumeration Date | 2021-10-09 |
| Last Update Date | 2025-03-21 |