| NPI | 1316015910 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-00-2367) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2008-10-16 |