| NPI | 1750051058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2911) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC098) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2022-06-29 |