| NPI | 1154468841 |
|---|---|
| Former Name | LAUREN POUPARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601005772) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA-C# 18643) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2015-07-31 |