| NPI | 1447768031 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010426) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 6247) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2025-08-19 |