NPI | 1790187441 |
---|---|
Former Name | MOLLIE E BASH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ME PA1636) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000969) |
Enumeration Date | 2014-09-24 |
Last Update Date | 2024-08-08 |