| NPI | 1831143833 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2110) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1596) |
| 363A00000X Physician Assistant (Licence: NY 007441) | |
| 363AM0700X Physician Assistant, Medical (Licence: TN 1803) | |
| 363A00000X Physician Assistant (Licence: KY TC487) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2016-12-13 |