| NPI | 1700842721 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0947) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NH 189) |
| 363A00000X Physician Assistant (Licence: CT 6026) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-05-07 |