| NPI | 1649505181 |
|---|---|
| Former Name | JESSICA RAE HUTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 4466) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4466) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 4466) | |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2024-02-23 |