NPI | 1184680431 |
---|---|
Former Name | TRUDIE DIANNE BOGUES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-201) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA-201) |
Enumeration Date | 2006-04-25 |
Last Update Date | 2023-08-02 |