| NPI | 1639455561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1656) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003223A) |
| 363A00000X Physician Assistant (Licence: OH 50.005959RX) | |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2023-03-07 |