| NPI | 1760951610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006262RX) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 023002) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2022-02-28 |