| NPI | 1063885861 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506356) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00521100) | |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2021-08-30 |