| NPI | 1831809789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064250) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RTO000394) |
| 363A00000X Physician Assistant (Licence: DE C5-0012037) | |
| Enumeration Date | 2022-12-01 |
| Last Update Date | 2024-03-29 |