| NPI | 1114357241 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO 2016022088) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IL 096003565) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MO 2013023009) | |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2024-04-24 |