NPI | 1033608443 |
---|---|
Former Name | STEPHANIE WALK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9111229) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9111229) |
Enumeration Date | 2018-05-02 |
Last Update Date | 2019-05-13 |