| NPI | 1083212344 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2701) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC966) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2022-05-23 |