| NPI | 1952534802 |
|---|---|
| Former Name | MISTY DETRAIZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12419) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4505-012) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2022-07-21 |