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Individual
MAXI EDRA DAX
Active
Individual
MAXI EDRA DAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10079306-1206
UT
Other
Enumeration date
09/14/2016
Last updated
01/25/2024
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