NPI | 1215119466 |
---|---|
Former Name | SARA JAIME MASTERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601012418) |
Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CO 1955) |
Enumeration Date | 2007-11-29 |
Last Update Date | 2024-07-29 |