NPI | 1164503108 |
---|---|
Former Name | TAMIKO L KOLKJEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004550) |
Additional Taxonomies | 231H00000X Audiologist (Licence: MI 1601000462) |
Enumeration Date | 2006-10-18 |
Last Update Date | 2014-12-03 |