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 |