| NPI | 1366853525 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0104848) | |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2019-06-27 |