| NPI | 1750803680 |
|---|---|
| Former Name | SAMANTHA LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54968) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2025-01-14 |