| NPI | 1679972749 |
|---|---|
| Former Name | JACQUELINE MARIE BOURASSA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110004669) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0005468) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2021-04-08 |