| NPI | 1730273673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL 758) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA996) |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA996) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-07-08 |