NPI | 1922556653 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005655Rx) |
Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 50.005655rx) |
363A00000X Physician Assistant (Licence: FL 9109958) | |
Enumeration Date | 2016-09-11 |
Last Update Date | 2021-04-19 |