| NPI | 1528119906 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 6032) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001348A) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA21714) | |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2017-05-10 |