| NPI | 1912251760 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KY PA1788) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC161) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2018-07-26 |