NPI | 1295257285 |
---|---|
Former Name | KATELYNN ELIZABETH AUSTIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 5636) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2017026689) |
Enumeration Date | 2017-07-11 |
Last Update Date | 2024-12-27 |