| NPI | 1376822379 |
|---|---|
| Former Name | ANDREA MANG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT 53187) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21719) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2023-11-27 |