NPI | 1073020798 |
---|---|
Former Name | JENNIFER LEE SELF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17651) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA063567) |
Enumeration Date | 2018-01-03 |
Last Update Date | 2024-02-21 |