| NPI | 1134463003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005976RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4570) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA4570) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2019-06-12 |