| NPI | 1275299802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2932) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: IN 10003551A) | |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-03-25 |