| NPI | 1972026276 |
|---|---|
| Former Name | SOPHIA JANE WAGNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005117) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2021-08-23 |