| NPI | 1205292497 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 4968) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004572RX) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2022-04-05 |