| NPI | 1912479528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005550RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08891) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2021-05-18 |