NPI | 1609384437 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 001008943) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC688) |
363A00000X Physician Assistant (Licence: KY PA2335) | |
Enumeration Date | 2018-01-15 |
Last Update Date | 2019-04-09 |