| NPI | 1578914842 |
|---|---|
| Former Name | CHANNDARA THACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059668) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA 1153) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2018-03-17 |