NPI | 1467890491 |
---|---|
Former Name | JESSICA JOY OSMAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006681) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006681) |
Enumeration Date | 2013-06-12 |
Last Update Date | 2022-07-21 |