| NPI | 1760765317 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1686) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC080) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2021-01-20 |