| NPI | 1053702498 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC793) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL2276) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2024-04-18 |