NPI | 1205901493 |
---|---|
Former Name | KATINA RAISTRICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 186430) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-002067) |
Enumeration Date | 2006-11-22 |
Last Update Date | 2013-05-01 |