| 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 |