| NPI | 1104218791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2458) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 4272) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2023-08-18 |