| NPI | 1942683248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11465) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2025-04-03 |