| NPI | 1568155307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3615) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA3615) |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA3615) | |
| Enumeration Date | 2023-05-29 |
| Last Update Date | 2025-07-01 |