| NPI | 1720065956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0003814) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002134) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-07-21 |