| NPI | 1740528611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.007421RX) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MN 11698) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2022-07-21 |