| NPI | 1568871846 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 60171) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI AT-48) |
| 363A00000X Physician Assistant (Licence: CA 60171) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2022-01-12 |