NPI | 1114453917 |
---|---|
Former Name | BRIANA HENKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085006230) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-05-11 |
Last Update Date | 2023-04-28 |