| NPI | 1215291679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10404) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 6169) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2021-08-09 |