NPI | 1366989006 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0008728) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-2554) |
363A00000X Physician Assistant (Licence: TX PA13584) | |
Enumeration Date | 2017-01-19 |
Last Update Date | 2025-04-03 |