| NPI | 1770559155 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA419) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NE 567) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2007-07-08 |