| NPI | 1922560002 |
|---|---|
| Former Name | MACKENZIE MAE LARSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58481) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2025-03-28 |