| NPI | 1700386232 |
|---|---|
| Former Name | AMANDA SUSAN BRADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008581) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601008581) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2021-12-09 |