| NPI | 1255933263 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 50.006744RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 1160683) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2021-03-08 |