| NPI | 1528742962 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065369) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008237RX) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-02-07 |