NPI | 1548540057 |
---|---|
Former Name | JENNIFER PITYLAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008932) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK 2322) |
Enumeration Date | 2011-08-29 |
Last Update Date | 2020-11-25 |