| NPI | 1588223754 |
|---|---|
| Former Name | AUTUMN SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-12035) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MA 7182) |
| 363A00000X Physician Assistant (Licence: CT 4474) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-04-01 |