NPI | 1376853085 |
---|---|
Former Name | KARLYN MARIE MISELIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 002500) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 2500) |
Enumeration Date | 2010-10-15 |
Last Update Date | 2012-09-10 |