| NPI | 1679973390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1256) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0353) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2017-05-11 |