| NPI | 1306469069 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-1051) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OH 50.006446RX) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2021-08-10 |