| NPI | 1730678178 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.007685RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000003400) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 3400) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-10-25 |