| NPI | 1952611485 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KY 1212) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1212) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2011-12-23 |