NPI | 1417679572 |
---|---|
Former Name | AMBER SERRETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA16146) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical | |
363AS0400X Physician Assistant, Surgical | |
Enumeration Date | 2022-09-15 |
Last Update Date | 2023-07-26 |