| NPI | 1518115765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 99048597A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1153) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2018-08-10 |