| NPI | 1659395895 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110-840857) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2411) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-02-05 |