| NPI | 1568777324 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005086RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004285) |
| 363AM0700X Physician Assistant, Medical (Licence: WV 01828) | |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2022-02-01 |