| NPI | 1164858882 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9107524) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4456) |
| 363A00000X Physician Assistant (Licence: NY 021612) | |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2022-10-28 |