| NPI | 1619147907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00385) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC003) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2020-08-17 |