| NPI | 1174880090 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VT 055.0031570) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VT 104.0085244) |
| 363A00000X Physician Assistant (Licence: NY 024052) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2023-01-23 |