| NPI | 1952692568 |
|---|---|
| Former Name | CAROLE ANNE BURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00255100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07801) |
| 363A00000X Physician Assistant (Licence: NY 014811-1) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2014-05-13 |