NPI | 1417334616 |
---|---|
Former Name | BRITTNEY WILSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010754) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.005974RX) |
363A00000X Physician Assistant (Licence: MA PA5306) | |
Enumeration Date | 2015-04-27 |
Last Update Date | 2024-04-03 |