| NPI | 1629530787 |
|---|---|
| Former Name | MACIE ALYSSA ENMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 2026-02378) |
| 208600000X Surgery (Licence: AL MD.43818) | |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2026-04-27 |