| NPI | 1265912059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4017) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC732) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-09-01 |