| NPI | 1326695792 |
|---|---|
| Former Name | HEIDI MICHELLE WALBERG |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 4630) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CT 4630) | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2024-11-13 |