| NPI | 1962568444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1801) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04863) |
| 363A00000X Physician Assistant (Licence: NC 0010-02273) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2015-06-04 |