| NPI | 1174169700 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA8956) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.006256RX) |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2023-03-21 |