NPI | 1558517912 |
---|---|
Former Name | DIEM JILLIAN TRAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004666) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.002789) |
363A00000X Physician Assistant (Licence: WV 01575) | |
363A00000X Physician Assistant (Licence: PA MA056113) | |
Enumeration Date | 2008-08-15 |
Last Update Date | 2018-04-24 |