NPI | 1639437379 |
---|---|
Former Name | STACI ROBIN GRAVES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 006500) |
Enumeration Date | 2012-05-01 |
Last Update Date | 2024-08-22 |