| NPI | 1124119201 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 2579) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1000484) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2008-05-22 |