| NPI | 1245417849 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002762) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: PA 1075639) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-07-29 |