| NPI | 1508215906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007749) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 2000022629) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-01-13 |