NPI | 1972078335 |
---|---|
Former Name | VICTORIA NICOLE IOAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08131) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08131) |
Enumeration Date | 2018-10-11 |
Last Update Date | 2019-09-05 |