NPI | 1336796002 |
---|---|
Former Name | ERIN REGAN GRANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010506) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4741-23) |
Enumeration Date | 2019-08-19 |
Last Update Date | 2023-01-04 |