| NPI | 1821307752 |
|---|---|
| Former Name | AMANDA JEANNE ROUSLIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA057526) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA057526) |
| 363A00000X Physician Assistant (Licence: NY 014268) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2020-08-11 |