| NPI | 1891205803 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.006396RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA059321) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2020-03-09 |