| NPI | 1962671792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002747RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2023-0005) |
| 363A00000X Physician Assistant (Licence: IL 085010041) | |
| 363A00000X Physician Assistant (Licence: MI 5601005409) | |
| 363A00000X Physician Assistant | |
| 363A00000X Physician Assistant (Licence: WI 7386) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2025-11-13 |