| NPI | 1760757991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10342) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 0561) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-10342) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2023-10-24 |