NPI | 1821372061 |
---|---|
Former Name | SARA RUTH CUMPSTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2034) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 7813) |
Enumeration Date | 2011-10-06 |
Last Update Date | 2018-05-14 |