| NPI | 1861945693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3183) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: OH 50.006551RX) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2023-10-17 |