| NPI | 1679034250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA060364) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.005848RX) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |