| NPI | 1720827199 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.010484RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110010043) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2026-08-07 |