| NPI | 1437702123 |
|---|---|
| Former Name | MICALA MARIE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1746) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 3090) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-11-14 |