| NPI | 1790839991 |
|---|---|
| Former Name | MARIE ANTOINETTE POLYCARPE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004312) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 004112-1) |
| 363A00000X Physician Assistant (Licence: WA PA10004312) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-06-09 |