NPI | 1881108157 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 119761) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
2255A2300X Specialist/Technologist, Athletic Trainer | |
Enumeration Date | 2017-11-25 |
Last Update Date | 2023-05-09 |