| NPI | 1154302388 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1114) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9101536) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA1114) | |
| Enumeration Date | 2005-11-05 |
| Last Update Date | 2015-02-16 |