| NPI | 1396837548 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1189) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110002383) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-08-06 |