| NPI | 1164938114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005397RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005397RX) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2024-02-05 |