| NPI | 1306981949 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: IN 10001189A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NE 273) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2012-09-26 |