| NPI | 1982264172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2566) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003280A) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-06-29 |