| NPI | 1780879924 |
|---|---|
| Former Name | ALYSA M FOG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 100240) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 100240) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2022-07-12 |