| NPI | 1922468438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004627RX) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2021-09-21 |