| NPI | 1811291172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC908) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WY TL509) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2020-01-10 |