| NPI | 1023052271 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1900) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA501) |
| 363AS0400X Physician Assistant, Surgical (Licence: KY 501) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-01-04 |