| NPI | 1023273216 |
|---|---|
| Former Name | EMILY JO LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0102205622) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OS014596) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2019-07-24 |