NPI | 1063912103 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 1278) |
Enumeration Date | 2018-02-15 |
Last Update Date | 2023-06-17 |