NPI | 1407119753 |
---|---|
Former Name | JULIE MONTGOMERY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: GA 006493) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6493) |
Enumeration Date | 2012-06-21 |
Last Update Date | 2021-01-22 |