| NPI | 1710661772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2774) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008723RX) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-12-02 |