| NPI | 1265749188 |
|---|---|
| Former Name | STEPHANIE BENJAMIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA153224) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA153224) |
| 363AM0700X Physician Assistant, Medical (Licence: PA MA054088) | |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2023-09-02 |