| NPI | 1073152666 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2021-08-18 |