| NPI | 1427225929 |
|---|---|
| Former Name | MARY HENRIETTE LANE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA 2416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2416) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |