| NPI | 1487190617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 6203) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: RI AT00439) | |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2023-09-06 |