| NPI | 1619141124 |
|---|---|
| Former Name | VICKI WATSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002438a) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.001964) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2019-07-22 |