| NPI | 1790763340 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0806) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-001731) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-10-14 |