NPI | 1194090050 |
---|---|
Former Name | CAILIN ANTONIA BRAZEAU |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004142) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA.0004142) |
363A00000X Physician Assistant (Licence: FL PA9106351) | |
Enumeration Date | 2012-03-12 |
Last Update Date | 2021-07-19 |