| NPI | 1508422973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC053) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 1162290) |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2021-06-15 |