| NPI | 1033617303 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 201273) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 201273) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AK 103320) | |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2023-11-13 |