| NPI | 1346394699 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA064151) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0000485) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 000133) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2022-11-05 |