NPI | 1477821130 |
---|---|
Former Name | BROOKE VANESSA PERDOMO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 164786) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106366) |
Enumeration Date | 2011-12-09 |
Last Update Date | 2021-07-02 |