| NPI | 1619056793 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006525RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 00906) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-28 |