NPI | 1770896847 |
---|---|
Former Name | JAMIE KATHLEEN MATER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9105496) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105496) |
Enumeration Date | 2010-07-19 |
Last Update Date | 2021-07-29 |