| NPI | 1588028088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 8207030-1206) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 8207030-4810) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2024-12-09 |