| NPI | 1972061166 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005889RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08920) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-04-20 |