NPI | 1588693196 |
---|---|
Former Name | MARCELLA DAWN DICKMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10000454A) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000454A) |
Enumeration Date | 2006-07-03 |
Last Update Date | 2021-03-15 |