| NPI | 1104224062 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT 91635) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT ATR-LAT-LIC-37) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2021-01-06 |