| NPI | 1659801207 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 13994826-1206) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ND 757-17) |
| 363A00000X Physician Assistant (Licence: FL PA911635) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-07-31 |