NPI | 1538203476 |
---|---|
Former Name | MICHELLE A BULLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1204) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001911) |
Enumeration Date | 2007-02-16 |
Last Update Date | 2023-05-01 |