| NPI | 1700517422 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3225) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC394) |
| 363AM0700X Physician Assistant Medical (Licence: KY TC394) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA3225) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY TC394) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA3225) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-10-25 |