| NPI | 1255815056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2430) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OH 50.00000) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA2430) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2430) | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2024-07-02 |