| NPI | 1174178032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 6371) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003031-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 001582) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2024-10-22 |