| NPI | 1194772400 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007827RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01121) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2023-12-14 |