| NPI | 1457519597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA 1145141) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25mt00137000) |
| 363A00000X Physician Assistant (Licence: CO PA.0007017) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2023-10-10 |