NPI | 1750811691 |
---|---|
Former Name | AMELIA GRACE MCCANE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8365) |
Additional Taxonomies | 208000000X Pediatrics (Licence: GA 8365) |
207Q00000X Family Medicine (Licence: GA 8365) | |
Enumeration Date | 2017-06-13 |
Last Update Date | 2025-10-07 |