| NPI | 1295280998 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2124) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA2124) |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2124) | |
| 363A00000X Physician Assistant (Licence: KY TC524) | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2020-08-17 |