NPI | 1174993109 |
---|---|
Former Name | CAITLIN MARY LEE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005099) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110005099) |
Enumeration Date | 2015-10-02 |
Last Update Date | 2024-08-07 |