| NPI | 1689761967 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: KY PA423) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013237-1) |
| 363AS0400X Physician Assistant Surgical (Licence: NY 13237) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2023-05-15 |