| NPI | 1700135563 |
|---|---|
| Former Name | LISA ALTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 61794) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055945) |
| 363A00000X Physician Assistant (Licence: NY 016344) | |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2023-05-09 |