| NPI | 1942689229 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005618RX) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2022-02-04 |