| NPI | 1649716796 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA192126) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA192126) |
| 363A00000X Physician Assistant (Licence: OH 50.004955RX) | |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50004955RX) | |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2021-01-07 |