| NPI | 1962754259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601013166) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2025-05-20 |