| NPI | 1134206055 |
|---|---|
| Former Name | KATHERINE ELIZABETH SHACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103957) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-01-14 |