NPI | 1508556200 |
---|---|
Former Name | ALYSSA DIGIOVANNA BRAVIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA101080) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2023-05-08 |
Last Update Date | 2024-10-17 |