| NPI | 1790229979 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009248) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005987RX) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C06320) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2023-09-05 |