| NPI | 1013375351 |
|---|---|
| Former Name | MELANIE KACZINSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2018-03-13 |