| NPI | 1336605617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2475) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC800) |
| 363AM0700X Physician Assistant Medical (Licence: KY PA2475) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2475) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2021-05-24 |