| NPI | 1770840233 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2219) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1722) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2020-02-27 |