| NPI | 1639898059 |
|---|---|
| Former Name | ALIX NICOLE BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA61799) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-02-06 |