| NPI | 1174065817 |
|---|---|
| Former Name | ALLIX BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3146) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 3146) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2020-07-14 |