| NPI | 1669845616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 0003136) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2029) |
| 363A00000X Physician Assistant (Licence: KY TC422) | |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2019-03-28 |