| NPI | 1720811607 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC021) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC021) |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2024-09-05 |