NPI | 1679913727 |
---|---|
Former Name | ALEXANDRA VITEK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005640) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 2268) |
Enumeration Date | 2013-07-02 |
Last Update Date | 2021-02-18 |