| NPI | 1326419292 |
|---|---|
| Former Name | KOURTNEY ELIZABETH HOLBROOK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10003248A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA10348) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2021-12-04 |