| NPI | 1710692579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA067652) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.007969) |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2026-06-16 |