| NPI | 1548713886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA58940) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT003010) |
| 363A00000X Physician Assistant (Licence: GA 9449) | |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2022-03-23 |