NPI | 1245290394 |
---|---|
Former Name | SONYA JUSTUS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ME PA001140) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA AP1899) |
363AM0700X Physician Assistant, Medical (Licence: NH 0783) | |
Enumeration Date | 2006-03-24 |
Last Update Date | 2013-12-27 |