| NPI | 1710533047 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 106822) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 106822) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2021-02-19 |