| NPI | 1972814697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MD C05099) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY PA1560) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2015-05-15 |