| NPI | 1932273687 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012618) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 375277-1206) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60747580) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-01-15 |