| NPI | 1164708558 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05259) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001924-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000669) | |
| Enumeration Date | 2011-10-29 |
| Last Update Date | 2016-10-03 |