| 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 |