NPI | 1073891149 |
---|---|
Former Name | CHARNAI DAWN FANKHANEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2808) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 2808-023) |
Enumeration Date | 2011-07-23 |
Last Update Date | 2021-11-22 |