| NPI | 1750565073 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006952RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA053258) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2021-07-28 |