| NPI | 1417920331 |
|---|---|
| Former Name | BETHANY GAMBLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008127) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI 2601000292) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-09-05 |