| NPI | 1619793841 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3630) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC003) |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2025-06-24 |