NPI | 1578897138 |
---|---|
Former Name | JAIME LYNN MAST |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10486) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 200319) |
Enumeration Date | 2009-09-29 |
Last Update Date | 2016-05-12 |