NPI | 1194114918 |
---|---|
Former Name | WHITNEY DIXON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MI 5601007590) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.005273) |
Enumeration Date | 2015-01-16 |
Last Update Date | 2021-02-23 |