| NPI | 1962850479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-88688) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.004901RX) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2020-12-08 |