| NPI | 1609659101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA065998) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008420RX) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2025-02-03 |