NPI | 1073975314 |
---|---|
Former Name | KAYLA DAVIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004604) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53268) |
363A00000X Physician Assistant (Licence: FL PA 9109147) | |
Enumeration Date | 2016-03-25 |
Last Update Date | 2016-05-05 |