| NPI | 1245632975 |
|---|---|
| Former Name | KRISTIE Y. CMOLUCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA-1151) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9108275) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2022-08-23 |