NPI | 1255450250 |
---|---|
Former Name | JOAN EVE MALCOUN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9110284) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601003492) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2022-06-13 |