NPI | 1265861793 |
---|---|
Former Name | BROOKE REBA PAUL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.003817RX) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OH 50.003817RX) |
Enumeration Date | 2013-11-05 |
Last Update Date | 2024-10-07 |