| NPI | 1861885535 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007316) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 305826) |
| 363A00000X Physician Assistant (Licence: MS PA00576) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2023-01-04 |