| NPI | 1194368787 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 59408) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 59408) | |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2022-03-25 |