| NPI | 1588002109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA OA005186) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000013499) |
| 363A00000X Physician Assistant (Licence: PA OA005186) | |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA061492) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2024-10-01 |