NPI | 1265683502 |
---|---|
Former Name | KRISTEN M. BISSONETTE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054821) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.002815) |
Enumeration Date | 2008-10-06 |
Last Update Date | 2021-03-15 |