| NPI | 1730178583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS T-01642) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50001684) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2007-10-25 |