| NPI | 1205286556 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2154) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 99076677A) |
| 363A00000X Physician Assistant (Licence: KY TC520) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2023-02-16 |