| NPI | 1689113383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061695) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005006RX) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2021-02-01 |