NPI | 1255582516 |
---|---|
Former Name | COURTNEY LEE ROSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 012856) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055386) |
Enumeration Date | 2008-10-06 |
Last Update Date | 2016-05-02 |