| NPI | 1558052324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.009947RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601011521) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2025-12-15 |