NPI | 1225428089 |
---|---|
Former Name | BROOKE LASSITER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113839) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL pa9113839) |
Enumeration Date | 2015-02-02 |
Last Update Date | 2023-10-06 |