| NPI | 1134986003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0009422) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT007346) |
| 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0012078) | |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2024-08-28 |