| NPI | 1639403710 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA1213) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1213) |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC045) | |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2021-03-09 |