| NPI | 1750625190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-04923) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 003654) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2021-05-03 |