NPI | 1194885541 |
---|---|
Former Name | KRISTA FREEMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056356) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0003085) |
Enumeration Date | 2006-12-08 |
Last Update Date | 2014-06-11 |