| NPI | 1164244257 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61637718) |
| Enumeration Date | 2024-10-29 |
| Last Update Date | 2025-01-10 |