| NPI | 1790885218 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50002313) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA 4208) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2013-02-22 |