NPI | 1104197391 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006582RX) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2561) |
363A00000X Physician Assistant (Licence: MI 5601006091) | |
Enumeration Date | 2012-01-19 |
Last Update Date | 2021-07-12 |