| NPI | 1831184712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA868) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 363AS0400X Physician Assistant Surgical (Licence: ID PA868) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2011-07-19 |