| NPI | 1578815932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1762) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC153) |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2022-02-15 |