| NPI | 1740742980 |
|---|---|
| Former Name | LYDIA M STOUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 23585) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2025-04-10 |