| NPI | 1154659043 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1621) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC013) |
| Enumeration Date | 2009-12-03 |
| Last Update Date | 2014-11-20 |