| NPI | 1922463645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA223291) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 55810) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 0010-06117) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2024-12-30 |