| NPI | 1790429538 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IA 114351) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2023-05-09 |