NPI | 1073550059 |
---|---|
Former Name | JULIE ANN MATHIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: GA 004724) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004724) |
Enumeration Date | 2006-05-31 |
Last Update Date | 2023-08-17 |