NPI | 1417581869 |
---|---|
Former Name | ANNE GORDON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1857) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: ID PA-1857) |
Enumeration Date | 2020-02-25 |
Last Update Date | 2023-12-15 |