NPI | 1598738635 |
---|---|
Former Name | TRINA GEBAUER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085002304) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001563) |
Enumeration Date | 2006-02-09 |
Last Update Date | 2014-01-15 |