NPI | 1225337132 |
---|---|
Former Name | LARISSA IVANOVNA RUN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA1268) |
Additional Taxonomies | 174400000X Specialist (Licence: NV PA1268) |
Enumeration Date | 2011-03-17 |
Last Update Date | 2024-10-10 |