| NPI | 1043817620 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14464)  | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| 363A00000X Physician Assistant (Licence: MA PA8440)  | |
| Enumeration Date | 2020-10-06 | 
| Last Update Date | 2024-09-27 |