| NPI | 1811440811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC171) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC171) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY TCA453) | |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC171) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2024-07-11 |