| NPI | 1003806993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9105043) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 1455198) |
| 363A00000X Physician Assistant (Licence: FL PA 9105043) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2016-05-20 |