NPI | 1073971644 |
---|---|
Former Name | ILIANA SUERO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: UT 9683489-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 9683489-1206) |
Enumeration Date | 2016-02-10 |
Last Update Date | 2022-09-19 |