| NPI | 1457085565 |
|---|---|
| Former Name | TATUM THOMAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10067) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2023-10-24 |