| NPI | 1922407030 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12586) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ID AT-440) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2017-11-14 |