NPI | 1861778615 |
---|---|
Former Name | LAUREL ANN BENSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 11413) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 5005) |
Enumeration Date | 2011-10-25 |
Last Update Date | 2021-03-10 |