NPI | 1558092700 |
---|---|
Former Name | HANNAH JO CASTOR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: TN 5062) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5062) |
Enumeration Date | 2022-06-20 |
Last Update Date | 2022-06-20 |