| NPI | 1972077303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 814) |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2023-02-20 |