| NPI | 1962586479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012693) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 18667) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-04-14 |