| NPI | 1508355538 |
|---|---|
| Former Name | MAURISSA RADAKOVICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1970) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2023-02-22 |