| NPI | 1114062528 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4145) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 4145) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1556) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2024-10-29 |