NPI | 1497409304 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3096) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC287) |
363AS0400X Physician Assistant, Surgical (Licence: KY TC287) | |
Enumeration Date | 2022-02-09 |
Last Update Date | 2023-03-28 |