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 |