| NPI | 1952751299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2320) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant Medical (Licence: KY PA2320) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2320) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2020-09-29 |