NPI | 1861024945 |
---|---|
Former Name | AVERY ROSE BAJEMA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13265) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 4967) |
Enumeration Date | 2020-02-06 |
Last Update Date | 2025-04-18 |