| NPI | 1568903391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 36670) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 2000006538) |
| 363AM0700X Physician Assistant, Medical (Licence: SC 1143416) | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2020-11-05 |