| NPI | 1376926691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.005666RX) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023275-1) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY B10015560) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2023-11-09 |