| NPI | 1083395800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 3092) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.009501RX) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2025-10-10 |