| NPI | 1679688287 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA052090) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 2365) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-06-08 |