| NPI | 1902666597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC173) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.008702RX) |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC173) | |
| 363AS0400X Physician Assistant, Surgical (Licence: KY TC173) | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-07-15 |