| NPI | 1033418140 |
|---|---|
| Former Name | JACQUELYN ANNE VIRGI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35126992) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT194821) |
| 208600000X Surgery (Licence: NC 2014-00901) | |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2015-09-30 |