| NPI | 1417615303 |
|---|---|
| Former Name | AUTUMN SKYE CANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110008202) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0000008202) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2024-08-25 |