| NPI | 1336854256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3232) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC381) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-09-25 |