| NPI | 1417402652 |
|---|---|
| Former Name | JESSICA MESIDOR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5170) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020023) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2021-09-15 |