| NPI | 1083795835 |
|---|---|
| Former Name | KATELYN MARIE MCNULTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA 2167) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 2167) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2011-11-02 |