| NPI | 1093175267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4788) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2094) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2021-01-13 |