| NPI | 1962837682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5739) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003854) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2021-04-12 |