NPI | 1972005601 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010619) |
Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: MI 2601001849) |
Enumeration Date | 2018-03-08 |
Last Update Date | 2023-10-23 |