NPI | 1902318066 |
---|---|
Former Name | ALLISON BETH BLOOM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 106S00000X Behavior Technician |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363A00000X Physician Assistant (Licence: FL PA9110749) | |
Enumeration Date | 2017-10-30 |
Last Update Date | 2022-08-07 |