| NPI | 1689211740 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OR AT-10165263) |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2024-10-29 |