| NPI | 1679789846 |
|---|---|
| Former Name | MARY MANNING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 000035) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 0000035) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2019-03-11 |