| NPI | 1699173302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2165) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC PA2212) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2022-11-04 |