NPI | 1942738943 |
---|---|
Former Name | SOPHAVY SUON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA19411) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 54512) |
Enumeration Date | 2017-06-02 |
Last Update Date | 2025-09-16 |