| NPI | 1003444183 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2893) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4640) |
| 363AM0700X Physician Assistant, Medical (Licence: TN 4640) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-08-21 |