| NPI | 1154653772 |
|---|---|
| Former Name | VICTORIA APOLLONIA LISOWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 3373) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04177) |
| Enumeration Date | 2010-02-06 |
| Last Update Date | 2013-03-21 |