| NPI | 1366693905 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1183) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-00796) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2010-11-19 |