| NPI | 1891505780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601013817) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.010246RX) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2026-05-05 |