NPI | 1114094679 |
---|---|
Former Name | SUSAN G BRASSIL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-0700) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA10418) |
363AM0700X Physician Assistant, Medical (Licence: NC 0010-00700) | |
Enumeration Date | 2006-11-29 |
Last Update Date | 2022-08-25 |