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 |