| NPI | 1225203128 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1096) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY 1096) |
| 174400000X Specialist (Licence: KY 1096) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA1096) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2013-08-07 |