NPI | 1760917579 |
---|---|
Former Name | ANGELA OKONTA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54393) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 10060) |
363A00000X Physician Assistant (Licence: WA PA61492457) | |
Enumeration Date | 2017-04-30 |
Last Update Date | 2024-02-05 |