| NPI | 1659764108 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 9149) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002214) |
| 363AM0700X Physician Assistant, Medical (Licence: OH 50.002214) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2024-04-23 |