| NPI | 1568829984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5427) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: NC P070358) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3504) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC NC2405) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2023-05-24 |