NPI | 1730141987 |
---|---|
Former Name | LESLIE L STANDORF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1933-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-79429) |
Enumeration Date | 2006-04-04 |
Last Update Date | 2021-02-15 |