NPI | 1306393103 |
---|---|
Former Name | TARAH LYNN ROBERTS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA186912) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-09-08 |
Last Update Date | 2021-04-21 |