| NPI | 1124211107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KY PA1068) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.004545) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2018-11-07 |