| NPI | 1710650916 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 12466843-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA209390) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2024-05-08 |