| NPI | 1003872664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50001263) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.022577) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2023-03-24 |