| NPI | 1720459605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005076RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.005076RX) |
| Enumeration Date | 2015-10-17 |
| Last Update Date | 2024-10-22 |