| NPI | 1073383964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3438) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008877RX) |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2024-09-20 |