| NPI | 1467872036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 139887) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 363AS0400X Physician Assistant, Surgical (Licence: AK 139887) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2023-11-13 |