| NPI | 1073234456 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC097) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.008470RX) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2023-12-08 |