| NPI | 1972964724 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010903) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004561RX) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2023-04-13 |