| NPI | 1942690326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007236) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 018371) |
| 363A00000X Physician Assistant (Licence: OH 50.006813RX) | |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2022-01-27 |