| 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 |