| NPI | 1003352832 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 1220918) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: 1220918) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CA 2000022551) | |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2024-07-03 |