| NPI | 1407072341 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9106038) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL PT22440) |
| 2083S0010X Preventive Medicine, Sports Medicine (Licence: FL AL1992) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-07-31 |