| NPI | 1295208130 |
|---|---|
| Former Name | CASEY GRACE KUPCHA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56500) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2022-02-23 |