| NPI | 1346454212 |
|---|---|
| Former Name | STACIE CHRISTINE GRAVES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005145RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005145RX) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2019-01-11 |