| NPI | 1629851563 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3282) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC043) |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2023-12-18 |