| NPI | 1972754778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006719) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MAO53727) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2022-10-28 |