NPI | 1275751315 |
---|---|
Former Name | DEJA MARIE TROJAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 2076) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9104225) |
Enumeration Date | 2007-04-23 |
Last Update Date | 2013-12-27 |