| NPI | 1104454768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003008A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: KY TC165) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-03-10 |