| NPI | 1861872517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6773) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007381) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-11-15 |