| NPI | 1740519693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.0051272RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.005127RX) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-02080) | |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2025-05-05 |