| NPI | 1043781552 |
|---|---|
| Former Name | KRISTEN KATHARINA GLICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VT 055.0031410) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VT 055.0031410) |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2021-12-07 |