| NPI | 1689635393 |
|---|---|
| Former Name | CAROLINE ELAINE SELF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3775) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA18212) |
| 363A00000X Physician Assistant (Licence: CA PA18212) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-09-03 |