| NPI | 1609140631 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 001-007147) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.004317RX) |
| 363A00000X Physician Assistant (Licence: VA 0110003835) | |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2017-04-21 |