| NPI | 1033546114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT MED-PAC-LIC-60482) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT ATR-LAT-LIC-52) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2018-03-17 |