| NPI | 1134588270 |
|---|---|
| Former Name | LAURA LOGAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7889) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 7889) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2020-04-22 |