| NPI | 1831269224 |
|---|---|
| Former Name | ALICIA RENEE LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085003359) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003359) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-03-07 |