NPI | 1013493451 |
---|---|
Former Name | ELIZABETH MYSHRAIL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA7813) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant Medical (Licence: MA PA7813) | |
363AM0700X Physician Assistant Medical (Licence: VA 0110006146) | |
Enumeration Date | 2018-07-18 |
Last Update Date | 2021-05-25 |