| NPI | 1558911420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2633) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA2633) |
| 363AS0400X Physician Assistant Surgical | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2633) | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2020-10-23 |