| NPI | 1760760946 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY 1099600) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.004447) |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2017-05-31 |