| NPI | 1528582921 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT003485) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4176) | |
| 363A00000X Physician Assistant (Licence: GA 10209) | |
| 363A00000X Physician Assistant (Licence: FL 9114244) | |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2022-06-17 |