| NPI | 1063838050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1876) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC262) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2021-03-09 |