NPI | 1265826275 |
---|---|
Former Name | KIMBERLY MARIE WISNIEWSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 018586) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007307) |
Enumeration Date | 2015-03-27 |
Last Update Date | 2019-09-03 |