NPI | 1205389350 |
---|---|
Former Name | KRISTIN BREZOVAR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA14901) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.004742RX) |
Enumeration Date | 2016-07-25 |
Last Update Date | 2022-11-17 |