| NPI | 1972266252 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9114879) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010767) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2021-10-14 |