| NPI | 1417726142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10004490A) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2024-08-14 |