NPI | 1417508425 |
---|---|
Former Name | BRIANNA MALIA GAYLETS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061055) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA061055) |
Enumeration Date | 2019-09-23 |
Last Update Date | 2022-11-17 |