| NPI | 1952754764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2021024746) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL2885) |
| 363A00000X Physician Assistant (Licence: SC 3540) | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2021-09-21 |