| NPI | 1689629099 |
|---|---|
| Former Name | AUTUMN A MCKENZIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MD C0003077) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110002073) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2011-07-11 |