NPI | 1467982348 |
---|---|
Former Name | REBECCA TRETIAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110009423) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 020830) |
363AM0700X Physician Assistant, Medical (Licence: CA 56506) | |
Enumeration Date | 2017-06-14 |
Last Update Date | 2024-01-30 |