| NPI | 1912918657 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA570) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003191A) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2021-05-27 |