| NPI | 1811667231 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2747) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GU PA21-04) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2024-07-03 |