NPI | 1578897591 |
---|---|
Former Name | JENIVI MARUCUT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 21199) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 2293) |
Enumeration Date | 2009-09-23 |
Last Update Date | 2015-05-13 |