| NPI | 1902877087 |
|---|---|
| Former Name | SYLVIA SOUTHWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: KY PA-123) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA123) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2019-04-18 |