| NPI | 1437589124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4063-23) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1507-39) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2021-12-21 |