| NPI | 1104165679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA6811) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 2358) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA6811) | |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2023-05-08 |