| NPI | 1104401694 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003491A) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2024-05-09 |