| NPI | 1164985867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY TC074) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2816) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 4845) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-06-20 |