| NPI | 1710633029 |
|---|---|
| Former Name | OLIVIA MARIE GHANNAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA17711) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010964) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2025-04-09 |