| NPI | 1699257618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3942) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA2408) |
| 363A00000X Physician Assistant (Licence: KY TC753) | |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2022-10-05 |