| NPI | 1982398145 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009690) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011742) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2023-12-29 |