| NPI | 1073252326 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC138) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA16873) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2024-04-26 |