NPI | 1437301637 |
---|---|
Former Name | JENNIFER DELUCIA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 3678) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003306) |
Enumeration Date | 2008-10-21 |
Last Update Date | 2023-09-05 |