| NPI | 1780649210 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: AZ 4535) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 0405) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2024-06-21 |