| NPI | 1770272437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3324) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC012) |
| 363A00000X Physician Assistant (Licence: KY TC012) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY PA3324) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY TC012) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY pa3324) | |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-01-10 |