| NPI | 1578120994 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 14226777-1206) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000035201) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-06-17 |