| NPI | 1265762082 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: KY PA2049) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: KY 972) |
| 363A00000X Physician Assistant (Licence: OH 50.004115) | |
| 363AM0700X Physician Assistant Medical (Licence: OH 50.004115) | |
| 363AS0400X Physician Assistant Surgical (Licence: OH 50.004115) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH 002745) | |
| Enumeration Date | 2009-12-29 |
| Last Update Date | 2018-08-23 |