NPI | 1326581877 |
---|---|
Former Name | KARISA EUSTACE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10003723A) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 360002624A) | |
Enumeration Date | 2016-11-30 |
Last Update Date | 2022-12-13 |