NPI | 1124731294 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC190) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13415) |
363AM0700X Physician Assistant, Medical (Licence: KY TC190) | |
363AS0400X Physician Assistant, Surgical (Licence: KY TC190) | |
Enumeration Date | 2023-01-03 |
Last Update Date | 2024-08-02 |