| NPI | 1396405502 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3602) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008161RX) |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2025-04-10 |