| NPI | 1093015745 |
|---|---|
| Former Name | THYRA ISABEL JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5665) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 014402) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2016-11-01 |