| NPI | 1336657527 |
|---|---|
| Former Name | LAUREN DETHOMAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0006484) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WY PA867) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2024-04-11 |