NPI | 1114969003 |
---|---|
Former Name | ELISABETH VANWYKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22308) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-002670) |
Enumeration Date | 2006-06-12 |
Last Update Date | 2012-09-10 |