| NPI | 1457463911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA1180) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC079) |
| 363AM0700X Physician Assistant, Medical (Licence: WV 781) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-10-19 |