NPI | 1063557338 |
---|---|
Former Name | LIBERTY MARCYZNSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10005203) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA573) |
Enumeration Date | 2007-02-21 |
Last Update Date | 2014-08-04 |