| NPI | 1467069914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NY 025799) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2023-12-07 |