| NPI | 1114512480 |
|---|---|
| Former Name | KRYSTAL DAWN AULTMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL 1778) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-04-07 |