| NPI | 1598258659 |
|---|---|
| Former Name | LARUA KEARIN THIEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA59858) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2022-01-24 |