| NPI | 1679991731 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004016RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-004016) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2021-05-05 |