| 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 |