| NPI | 1770672172 |
|---|---|
| Former Name | NIKKI ANN GILIAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9103180) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9103180) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-09-10 |