| NPI | 1154753317 |
|---|---|
| Former Name | TRACIE M GEORGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0001041) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA056271) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2020-09-22 |