| NPI | 1861601437 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA 53437) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 363AS0400X Physician Assistant Surgical (Licence: NY 015283) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-01-03 |