| NPI | 1700150810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6023) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055443) |
| 363A00000X Physician Assistant (Licence: OH 50.003482) | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2015-08-12 |