| 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 |