| NPI | 1134674682 |
|---|---|
| Former Name | KACIE JO BAHR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12138) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MN 12138) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2019-03-18 |