| NPI | 1902551146 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3063) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC272) |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2022-12-16 |