| NPI | 1326448002 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 832) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NE 2651) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2021-09-30 |