| NPI | 1548301203 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50003310) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 363A00000X Physician Assistant (Licence: NH 0624) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2024-11-05 |