| NPI | 1336610856 |
|---|---|
| Former Name | OLIVIA LAUREL WEISS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL 9111738) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9111738) |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2024-01-26 |