| NPI | 1518226240 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1734) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC106) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2022-03-23 |