| NPI | 1578759536 |
|---|---|
| Other Name | CHARLENE OLIVIA JUSTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 3263) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 51298) |
| 363A00000X Physician Assistant (Licence: NC 0010-06058) | |
| Enumeration Date | 2007-09-23 |
| Last Update Date | 2019-08-04 |