NPI | 1891450565 |
---|---|
Former Name | RILEY MAE FLAKE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085009920) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2021-11-07 |
Last Update Date | 2023-08-23 |