| NPI | 1972511533 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004095) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1265-023) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-03-07 |