| NPI | 1912634759 |
|---|---|
| Former Name | LARA GRACE PARKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-15296) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 11120) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2025-07-30 |