| NPI | 1588056147 |
|---|---|
| Former Name | MIRANDA BOECKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-799) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085005407) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2021-09-29 |