| NPI | 1386074052 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2490) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003945) |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2019-11-14 |