NPI | 1154386654 |
---|---|
Former Name | LISA BRANDT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115253) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004326) |
Enumeration Date | 2006-04-18 |
Last Update Date | 2022-12-21 |