| NPI | 1336236744 |
|---|---|
| Former Name | TATYANA ALEXANDROVNA MISHUROVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR REF#153868) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0003088) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2014-06-04 |