| NPI | 1225698467 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2507) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IN 10003835A) | |
| 363A00000X Physician Assistant (Licence: IN TH0004004) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2022-12-22 |