| NPI | 1457718843 |
|---|---|
| Former Name | THEA LIBBOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA63893) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA13908) |
| 363A00000X Physician Assistant (Licence: NY 019399) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 019399) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 019399) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2025-02-21 |