NPI | 1891238465 |
---|---|
Former Name | TIFFANY ILANA GREEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54036) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 54036) |
363AS0400X Physician Assistant, Surgical (Licence: CA 54036) | |
Enumeration Date | 2016-11-29 |
Last Update Date | 2017-07-07 |