| NPI | 1669753810 |
|---|---|
| Former Name | MARY CATHERINE PARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1677) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 1677) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2022-04-25 |