| NPI | 1720081565 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA628) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TN PA806) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2007-11-09 |