| NPI | 1982757167 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA 717) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001184) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2013-09-10 |