NPI | 1205943776 |
---|---|
Former Name | HOLLY KAY SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005511) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-001788) |
363AS0400X Physician Assistant, Surgical (Licence: NC 0010-00319) | |
Enumeration Date | 2006-08-23 |
Last Update Date | 2018-09-07 |