| NPI | 1265829337 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AL 1621) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: GA AT002422) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-04-19 |