NPI | 1487940003 |
---|---|
Former Name | COURTNEY HALSDORF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NY 014802) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 014802) |
Enumeration Date | 2011-06-22 |
Last Update Date | 2023-12-07 |