| NPI | 1871129817 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007798) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003924-01) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2023-08-15 |