| NPI | 1992703383 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA369) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA 369) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2015-04-03 |