| NPI | 1407246135 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 10636633-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004282RX) |
| 363AS0400X Physician Assistant Surgical (Licence: OH 50.004282) | |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2019-03-07 |