| NPI | 1194228684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2967) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 10732519-1206) |
| 363A00000X Physician Assistant (Licence: MO 2018013895) | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2022-09-27 |