| NPI | 1083710446 |
|---|---|
| Former Name | MARIBETH WIDAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 4711) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 006082) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2023-04-05 |