| NPI | 1669206553 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3576) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008960RX) |
| Enumeration Date | 2024-09-02 |
| Last Update Date | 2025-03-21 |