| NPI | 1306498605 |
|---|---|
| Former Name | AE MARY VILAYVONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN145963) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: GA RN110412) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-11-29 |