| NPI | 1134196520 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008105RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003489) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2023-08-25 |