| NPI | 1760861264 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9117451) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-004281) |
| 363AM0700X Physician Assistant Medical (Licence: PA MA057652) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2024-06-14 |