| NPI | 1154945442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007683RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NM PA2021-0005) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-05-23 |