| NPI | 1225564800 |
|---|---|
| Other Name | MARIAM BOKOLISHVILI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 15-489) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 15-489) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2018-05-09 |