| NPI | 1134630528 |
|---|---|
| Former Name | TABITHA ROACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2025-01-29 |