| NPI | 1518309756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1822) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA1822) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2015-03-27 |