| NPI | 1326311242 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 9180) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: GA AT002088) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001759A) | |
| 363A00000X Physician Assistant (Licence: GA 9180) | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2020-09-11 |