NPI | 1255908091 |
---|---|
Former Name | KRISTEN GRACE DINSMORE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5220) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 5220) |
Enumeration Date | 2021-06-09 |
Last Update Date | 2024-09-18 |