| NPI | 1972868651 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5361) |
| 363A00000X Physician Assistant (Licence: KY TC837) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2022-04-22 |