| NPI | 1609109024 |
|---|---|
| Former Name | TRACY MARIE LAZUR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA054091) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21436) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2015-09-14 |