| NPI | 1386647261 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: KY PA839) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-00-2067) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-07-08 |