NPI | 1376042507 |
---|---|
Former Name | BETHANY A BENNETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA11769) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX PA11769) |
Enumeration Date | 2018-02-02 |
Last Update Date | 2025-06-11 |