| NPI | 1376949388 |
|---|---|
| Former Name | REBECCA MARIE PETROS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005277) |
| 363A00000X Physician Assistant (Licence: OH 50.004540) | |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2022-01-31 |