| NPI | 1164705430 |
|---|---|
| Former Name | CARLY GIETLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004054) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2023-06-15 |