| NPI | 1225666555 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-04-24 |