NPI | 1154383073 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-02693) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0267) |
Enumeration Date | 2006-04-05 |
Last Update Date | 2021-01-01 |