| NPI | 1104339282 |
|---|---|
| Former Name | MICHELLE ANNELIESE CARDENAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110641) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9110641) |
| Enumeration Date | 2017-11-10 |
| Last Update Date | 2018-03-08 |