| NPI | 1851468193 |
|---|---|
| Former Name | ABIGAIL BLAIR MITHOEFER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 829) |
| 363AM0700X Physician Assistant, Medical (Licence: MA 829) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2018-12-18 |