| NPI | 1922428820 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-1174) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AR 577) |
| Enumeration Date | 2014-04-18 |
| Last Update Date | 2023-06-19 |