NPI | 1992012090 |
---|---|
Former Name | AMANDA DEAL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054519) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2010-09-10 |
Last Update Date | 2014-10-29 |