NPI | 1568819456 |
---|---|
Former Name | KARISSA ROSE WESS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA060389) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: NY 019706-1) | |
Enumeration Date | 2016-05-20 |
Last Update Date | 2020-10-14 |