| NPI | 1619951985 |
|---|---|
| Former Name | AMANDA LORIS WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 003997) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003997) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2009-10-01 |