| NPI | 1104392588 |
|---|---|
| Former Name | KRISTINA ALYSE MAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 0010-08570) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2025-12-22 |