| NPI | 1922596162 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 2409) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: KY PA2367) | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-08-24 |