NPI | 1790910081 |
---|---|
Former Name | MEGAN LARSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3116) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 872) |
Enumeration Date | 2009-05-15 |
Last Update Date | 2015-06-01 |