NPI | 1104283365 |
---|---|
Former Name | KAYLYN PRICE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601011711) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-005201) |
Enumeration Date | 2016-01-19 |
Last Update Date | 2023-07-11 |