NPI | 1548537285 |
---|---|
Former Name | STEPHANIE MARTZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601006212) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601006212) |
Enumeration Date | 2011-11-23 |
Last Update Date | 2024-04-02 |