| NPI | 1508172438 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2481) |
| 363AM0700X Physician Assistant, Medical | |
| 363AM0700X Physician Assistant, Medical (Licence: TN 2481) | |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2023-08-09 |