| NPI | 1265401608 |
|---|---|
| Former Name | LISA ROOT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 003206-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 3206) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2023-03-21 |