NPI | 1376283960 |
---|---|
Former Name | TIFFANY STAPORNKUL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant |
Additional Taxonomies | 363AM0700X Physician Assistant Medical |
Enumeration Date | 2022-03-31 |
Last Update Date | 2022-06-21 |