| NPI | 1508605502 |
|---|---|
| Former Name | SOPHIA MARIE OLMSTEAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 64476) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-10-14 |