| NPI | 1790209476 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2296) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003112A) |
| 363A00000X Physician Assistant (Licence: KY 1145257) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2021-08-20 |