NPI | 1346624723 |
---|---|
Former Name | JESSICA LITTLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 3962) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 5439) |
Enumeration Date | 2015-07-15 |
Last Update Date | 2024-01-15 |