| NPI | 1750363859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.001924RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA811) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2025-08-14 |