| NPI | 1710605084 |
|---|---|
| Former Name | MIA ELIZABETH MATIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 333883) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2022-11-09 |