| NPI | 1104267749 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109278) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OH 50.003862) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2023-06-26 |