NPI | 1669479085 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA269) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA269) |
363AS0400X Physician Assistant, Surgical (Licence: KY PA269) | |
Enumeration Date | 2005-06-30 |
Last Update Date | 2025-01-28 |