| NPI | 1770234189 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008499RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010946) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-01-05 |