| NPI | 1457543845 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01327) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY 1013) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2009-09-02 |