| NPI | 1881003036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2156) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: KY 1821) |
| 133V00000X Dietitian, Registered (Licence: KY 954485) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA2156) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2156) | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2020-12-09 |