| NPI | 1619628237 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2925) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: KY pa2925) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY PA2925) | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2022-07-05 |