| NPI | 1215912712 |
|---|---|
| Former Name | AMY GOULEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA179314) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 17111) |
| 363AM0700X Physician Assistant, Medical (Licence: WA 60240552) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2024-08-08 |