| NPI | 1962391300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC043) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC043) |
| 208D00000X General Practice (Licence: KY TC043) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 363AM0700X Physician Assistant, Medical (Licence: KY TC043) | |
| Enumeration Date | 2025-07-01 |
| Last Update Date | 2026-08-20 |