| NPI | 1255769097 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC519) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08659) |
| Enumeration Date | 2013-10-14 |
| Last Update Date | 2017-01-26 |