| NPI | 1669863320 |
|---|---|
| Former Name | AMANDA RANDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IL 036155599) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2023-02800) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2026-05-18 |