NPI | 1407335094 |
---|---|
Former Name | KYLA K ALTMANN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002568A) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10002568A) |
Enumeration Date | 2018-08-14 |
Last Update Date | 2022-03-03 |