NPI | 1407154354 |
---|---|
Former Name | AMANDA S. WOLF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3281-23) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4138) |
363AM0700X Physician Assistant, Medical (Licence: WI 3281-23) | |
Enumeration Date | 2011-03-02 |
Last Update Date | 2023-04-10 |