NPI | 1538687850 |
---|---|
Former Name | CHELSEA DEMUTH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WI 4147) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2017-09-07 |
Last Update Date | 2021-11-01 |