NPI | 1124374319 |
---|---|
Former Name | ALI KING AMUNDSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.004711RX) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
Enumeration Date | 2012-07-25 |
Last Update Date | 2018-03-17 |