NPI | 1609161694 |
---|---|
Former Name | ANNA PERDOMO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 002903) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NJ 25MP0024980) |
Enumeration Date | 2011-06-17 |
Last Update Date | 2018-11-14 |