| NPI | 1144238254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006530RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA1197) |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10001262) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-08-11 |