| NPI | 1083965024 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2239) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0004897) |
| 363A00000X Physician Assistant (Licence: NC 0010-04801) | |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2018-01-15 |