NPI | 1134695265 |
---|---|
Former Name | AUBREY ROTH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-803) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PT2018-040) |
363A00000X Physician Assistant (Licence: NC 0010-09039) | |
Enumeration Date | 2018-10-16 |
Last Update Date | 2022-09-29 |