NPI | 1689112831 |
---|---|
Former Name | BROOKE ASHLEY DAY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12763) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 2779) |
363A00000X Physician Assistant (Licence: TX TEMPORARY) | |
Enumeration Date | 2017-02-08 |
Last Update Date | 2019-08-19 |