NPI | 1235754490 |
---|---|
Former Name | MCKENZIE SIMPSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 12464746-1206) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 12464746-1206) |
Enumeration Date | 2020-06-13 |
Last Update Date | 2023-12-04 |