| NPI | 1447373907 |
|---|---|
| Former Name | MYRA CELESTE LAZO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00302000) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052978) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2017-01-19 |