| NPI | 1316104953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1835) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1596) |
| 363A00000X Physician Assistant (Licence: IN 10001620A) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2015-01-23 |