| NPI | 1114236478 |
|---|---|
| Former Name | AMANDA MICHELLE SAMPLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52716) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2019-08-08 |