| NPI | 1396773628 |
|---|---|
| Former Name | AMANDA SIMMONS LAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 33644) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 33644) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-04-24 |