NPI | 1518423052 |
---|---|
Former Name | JILLIAN FOSTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 023305) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 023305) |
Enumeration Date | 2019-02-20 |
Last Update Date | 2023-04-20 |