NPI | 1104570738 |
---|---|
Former Name | MARY M CASE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00637) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: MS PA00637) |
Enumeration Date | 2022-02-11 |
Last Update Date | 2023-05-10 |