| NPI | 1710215835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 6312424-1206) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: UT 6312424-4810) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2021-10-21 |