| NPI | 1174134050 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC187) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 9737) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2022-03-24 |