NPI | 1154724631 |
---|---|
Former Name | BRIANNA REILLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA057216) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA OA003404) |
Enumeration Date | 2014-09-29 |
Last Update Date | 2022-12-21 |