| NPI | 1700867637 |
|---|---|
| Former Name | MICHELLE MARIE MA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA04588) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA15876) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-11-06 |