| NPI | 1477980480 |
|---|---|
| Former Name | HEATHER MICHELLE REZNIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CT 3003) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 23.003003) |
| 363AS0400X Physician Assistant Surgical (Licence: CT 23.003003) | |
| 363AS0400X Physician Assistant Surgical (Licence: RI 00729) | |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2018-11-08 |