| NPI | 1386178929 |
|---|---|
| Former Name | LAURA NICOLE PAVLOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0006827) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2018-05-25 |