| NPI | 1295704328 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA 21933) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096-002133) |
| 363A00000X Physician Assistant (Licence: CO 2846) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2012-05-08 |