| NPI | 1790112589 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009731) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0110009731) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000001660) | |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2024-04-15 |