NPI | 1790278778 |
---|---|
Former Name | AMANDA PUTRUS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601008688) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2018-06-13 |
Last Update Date | 2020-02-01 |