| NPI | 1548678907 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC PA031054) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT004717) |
| 363AM0700X Physician Assistant, Medical (Licence: VA 0110-004647) | |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2015-07-19 |