| NPI | 1871067819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601009008) |
| Enumeration Date | 2019-01-13 |
| Last Update Date | 2022-06-14 |