| NPI | 1386122901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-006524) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2327) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-03-01 |