| NPI | 1760515308 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.002724) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051830) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2008-01-07 |