NPI | 1245483486 |
---|---|
Former Name | ANGELA C. TISON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005464) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005464) |
Enumeration Date | 2008-10-31 |
Last Update Date | 2014-01-31 |