NPI | 1629535307 |
---|---|
Former Name | COURTNEY R DAVIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9111862) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10406) |
Enumeration Date | 2019-02-28 |
Last Update Date | 2024-09-20 |