NPI | 1083171375 |
---|---|
Former Name | MARY MORHARDT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 7416) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 7416) |
Enumeration Date | 2019-02-22 |
Last Update Date | 2021-11-03 |