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 |