| NPI | 1720736648 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3087) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA3087) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY PA3087) | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2024-04-05 |