| NPI | 1578956371 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2491) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 666) |
| 363AM0700X Physician Assistant, Medical (Licence: NE 2491) | |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2022-04-26 |