NPI | 1154738672 |
---|---|
Former Name | GABRIELLE JOHNSTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 4007) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-07028) |
Enumeration Date | 2014-07-16 |
Last Update Date | 2022-01-20 |