NPI | 1013461581 |
---|---|
Former Name | AUTUMN ELIZABETH DEGROAT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007826) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 58848) |
Enumeration Date | 2016-08-12 |
Last Update Date | 2024-10-29 |