| NPI | 1780014175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 027030) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ME AT469) |
| 363A00000X Physician Assistant (Licence: CA 62928) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2025-10-22 |