| NPI | 1295184703 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AK 155981) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AK 149324) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000793) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-07-14 |