| NPI | 1972191575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 60720) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010289) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2022-05-26 |