NPI | 1225407141 |
---|---|
Former Name | ALEXI A TETRAULT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 5068) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: DC DI100000733) |
363AS0400X Physician Assistant, Surgical | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-09-21 |
Last Update Date | 2025-02-27 |