NPI | 1396252862 |
---|---|
Former Name | AVERY SILLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA 61174295) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: 021653) |
Enumeration Date | 2018-01-05 |
Last Update Date | 2023-03-22 |