| NPI | 1700255668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2021) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC424) |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2023-07-17 |