| NPI | 1487321295 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9120016) | 
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007847RX) | 
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.007547RX) | |
| Enumeration Date | 2021-08-28 | 
| Last Update Date | 2025-07-03 |