| NPI | 1740654490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004458RX) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: OH 50004458) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2022-06-07 |