NPI | 1417250317 |
---|---|
Former Name | SUSAN WANG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55931) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA16924) |
Enumeration Date | 2010-12-15 |
Last Update Date | 2024-06-06 |