| NPI | 1013284306 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA062757) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005065) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA005769) | |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2023-06-22 |