| NPI | 1700507423 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007785RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 1177430) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2022-11-16 |