| NPI | 1790458982 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-14162) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MS PA00670) |
| 363A00000X Physician Assistant | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2024-12-11 |