| NPI | 1023439056 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062662) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 363A00000X Physician Assistant (Licence: TX PA15152) | |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2021-11-03 |