| NPI | 1104607217 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TC068) |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2025-11-05 |