| NPI | 1912123977 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT2784) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-03-19 |