| NPI | 1649656059 |
|---|---|
| Former Name | MARIE ANNETTE HERZOG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008091) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085005540) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2017-09-11 |