| NPI | 1710265053 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KY PA1644) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 10001296A) |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 10001296A) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY TC024) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-12-02 |