| NPI | 1275179830 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2613) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY 1158511) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA2613) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY PA2613) | |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2023-11-08 |