| NPI | 1528400629 |
|---|---|
| Former Name | TARA L ELTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010328) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 5447) |
| 363AM0700X Physician Assistant, Medical (Licence: WI 3747-23) | |
| 363AM0700X Physician Assistant, Medical (Licence: ME PA1799) | |
| Enumeration Date | 2013-07-18 |
| Last Update Date | 2021-07-19 |