| NPI | 1114304284 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 9174) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001944) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2019-03-10 |