| NPI | 1952813735 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA17860) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT7188) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 7188) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2024-04-01 |