| NPI | 1922697564 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2910) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant (Licence: KY TC097) | |
| Enumeration Date | 2021-01-17 |
| Last Update Date | 2022-05-10 |