| NPI | 1790267664 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006249RX) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363A00000X Physician Assistant (Licence: KY TC765) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2019-10-23 |