| NPI | 1548652720 |
|---|---|
| Former Name | KIMBERLY KOWALCZYK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085005725) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 23.003285) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2024-05-31 |