NPI | 1760932040 |
---|---|
Former Name | EMILY MARISSA REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 020236) |
Enumeration Date | 2016-10-10 |
Last Update Date | 2023-01-11 |