NPI | 1962445080 |
---|---|
Former Name | AUTUMN NICOLE TRAVIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601004117) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2006-06-14 |
Last Update Date | 2023-02-21 |