| NPI | 1982949319 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005098RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11285) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2021-03-04 |