NPI | 1639622715 |
---|---|
Former Name | KATHRINE W GAMMON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 12226) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2016-07-26 |
Last Update Date | 2020-10-09 |