| NPI | 1780418400 |
|---|---|
| Former Name | EMILY CLAIRE MANNISTO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601012689) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601012689) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2024-12-30 |