| NPI | 1972924496 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2162) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX E9052) |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2021-03-03 |