| NPI | 1891316212 |
|---|---|
| Former Name | AMANDA SMOTHERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085007967) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2022-05-04 |