NPI | 1336379106 |
---|---|
Former Name | TRACY CAROLE WATSON WANG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-01893) |
Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
Enumeration Date | 2009-07-15 |
Last Update Date | 2023-03-03 |