| NPI | 1063014553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC020) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2023-09-14 |