| NPI | 1891264388 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009610) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MI 5601009610) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2022-11-07 |