| NPI | 1962494450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9109552) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA902) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2022-04-18 |