| NPI | 1881217826 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15093) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-4170) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-03-10 |