| NPI | 1790165454 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1999) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2019-12-06 |